New research conducted by the Perelman School of Medicine finds that combining Cytotec and Foley catheters for labor induction speeds up the process of labor. Some have taken this to mean that using these two items is a safe way to reduce labor time, sparing mothers nearly four hours of labor and saving hospitals money. It’s important to remember, however, that labor induction with Cytotec (common name misoprostol) has risks that patients should be informed of. While prolonged labor does itself carry risks for mother and child, improper induction can further increase the risk of infant brain damage, uterine hyperstimulation, and uterine rupture if done improperly.

It’s important to note that the American Congress of Obstetricians and Gynecologists has specifically warned physicians that Cytotec shouldn’t be used in women who’ve had any previous C-sections, because there is a much higher risk of uterine rupture. Uterine rupture occurs when the uterus becomes overstimulated and partially or fully tears. According to the 2009 ACOG Guidelines Regarding Induction of Labor (which we reaffirmed in 2013), “…Inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of uterine rupture (which can be catastrophic).” [Emphasis added.] Cytotec is also unsuitable for women who’ve had prior uterine surgery or several prior births  because this increases the risk of uterine scarring. This is further confirmed firmly by the FDA, whose pamphlet on Cytotec specifically mentions the risk of uterine rupture as one key  – and possibly severe – side effect.

Uterine ruptures can result in hemorrhage, which can be life-threatening to both mother and baby. The resultant low blood pressure can cause hypoxic-ischemic encephalopathy (HIE) and cerebral palsy in the infant.

To avoid the risks of uterine hyperstimulation, uterine rupture and medication-related birth injury, medical practitioners should be carefully monitoring the mother’s response to the drug as well as the baby’s fetal heart rate tracings. If the fetal monitor demonstrates that mother’s uterus is being hyperstimulated, then induction medications need to be decreased or stopped. The baby’s heart rate must be watched closely to see if the baby’s heart rate starts to drop during contractions, it can mean that the fetus is in distress and being deprived of oxygen.  

• Because Cyototec (misoprostol) is typically administered and absorbed vaginally, it can’t just be turned off like an IV drip-administered induction drug (such as Pitocin) can.
• If Cytotec induction fails, there may be an increased need for an emergency C-section to prevent oxygen deprivation to the baby.  
• Lastly, there is no way to predict how a mother will react to Cytotec. A dose that can have zero effect in one mother might cause severe hyperstimulation (overly-strong contractions) in another.

For more information on Cytotec labor injuries, please see the following links:

• Risks of Cytotec for Labor Induction
• New High-Concentration Cytotec Formulations Increase Risk of Excessive Uterine Contractions (Tachysystole)
• Speeding Up Labor Isn’t Always Safe
• Cytotec Manufacturer Warning Against Using Cytotec for Induction and ACOG’s Response to the Manufacturer

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